Current Concepts Review
Impingement with Total Hip Replacement
JBJB 2007
Aamer Malik, MD, Aditya Maheshwari, MD, and Lawrence Dorr, MD

For hip stability:
Evaluate the x-rays and template
Be wary of hypermobile patients and spine patients
Know your implants (head options, neck options, etc)
Check patients supine and again lateral (for posterior approach)
Meticulous approach
Proper reaming and cup placement and remove osteophytes
Proper broaching and remove osteophytes

Check Ranawat sign
1. 45 degrees for females
2. 20 - 30 degrees for males

How I test stability
1. leg length
2. capsular tension and palpate offset
3. extension and rectus tension
4. extension and external rotation
5. position of sleep
6. full flexion in neutral
7. 90 degrees, slight adduction and internal rotation
8. assess intraoperative x-rays
Then make changes based on stability.

& so much more
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